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Managed Care

Managed Care

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Published by: ocirs on Feb 27, 2008
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10/14/2011

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Concentrate on What the Employer Wants
This is usually sold to an employer as a group product. While the employer will receive health
coverage for his employees, he is really buying something else. He is trying to obtain as much
satisfaction for his employees as his premium dollars can buy. He is trying to keep a trained
workforce in place. This includes health coverage that the employees are satisfied with.

A Better CE

All Rights Reserved, Richard Levine

62

Consider the Reputation of the Plan You Offer
Employee satisfaction begins with the reputation of the plan that is providing coverage. The
employee is looking for a choice of physicians, and minimum out-of-pocket expenses such as co-
payments. In the original HMO there was no choice of physician. Employees found this highly
objectionable, and the response was the formation of the PPO. This created a greater choice of
physician, as well as some coverage outside of the network. As the dynamic growth of both
HMO and PPO slowed down due to a saturation of the market, HMOs sought to increase their
market share by offering a Point of Service plan or POS.

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